It always amuses me when people try to make analogies between medicine and other kinds of commerce. It shows a profound lack of understanding how different the practice of medicine is from, say, the travel industry. I don't just show up at the airline counter and expect to fly that day.

If you show up to the Hilton and there are no rooms in the Inn, Hilton says, sorry about your luck. They are not legally obligated to house you, whereas doctors are (failing to do so is called abandoning the patient). If all that is available is a single and you want to house your family of 4, too bad, take it or leave it. Try shortchanging a patient because she is shoehorned into an inappropriately short office visit. Hilton Hotels don't shut down for several days because their is an a shortage of employees at the Marriot and everyone leaves to go help (read: hospital emergencies).

So the smart consumer makes a reservation (especially at high utilization time.) What the Hilton does is have (some) excess capacity (some of the time,) The walk in will end up paying top dollar if he gets into the hotel at all. Try that with Medicare patients and you'll be doing time in prison.

I agree that open access CAN work, but it works best for those practices where the needs are usually acute (pediatrics), predictable in time utilization (many primary care offices) and most of the visits do not be set up at an interval.If I know I need to recheck a cancer patient in 6 months, why not schedule it now, for six months from now?

How doctors do prostest! You are NOT the Hilton. But you're the ones who have made your practices more commercial. It's doctors who gravitate to fields and places that will enrich them instead of practices and places in greatest need. Ever try to find an endocronologist in DC? No? There's a small handful of them, despite a huge and desperate need. But hey - if I need some sort of botox injections, I need only turn to the Washingtonian and read the range of ads. Someone will see me in a week. That's really the crux of the problem -

But they are 2 separate problems. (Most) doctors would agree that it is not ideal for a system to favor cash-paying people over insurance-covered patients when the issues may be life-threatening, with the implication that people are told there really are no appointments for weeks until its a request for a cash-paying visit. It's much different to try to make the really lousy (and medically ignorant) analogy between a restaurant and an MD to argue that same day calls are the best way to manage an office.

Of course, all analogies break down at some point. But that doesn't mean they're not useful in gaining fresh perspective and insight into a problem. Mark Murray, the doctor I mention in my article who started the open-access movement, says that the most common criticism he hears from doctors is, "Yeah, but we're different." If the goal is to justify the status quo, then that's an effective response. But what if the goal is to find a way out? Then I'd be looking at how others have done it. And at this point we don't need to look outside of medicine, given all the doctors' offices that have made same-day scheduling work.

Marina

Its one thing to make an appointment 6 months in advance for a check up. Its another when your back has begun to hurt so badly you cannot earn your living.

If someone is vomiting for a day and a half with serious cramps should they wait six months to see their doctor?

Its one thing to schedule an appointment with your plumber, if he can't get there for a week there is another one in the paper you can call if you so choose. But one cannot switch doctors like one can switch plumbers.

The only alternative people have then is to continue to clog this nations emergency rooms with problems that would be better and more cheaply treated in earlier stages at a family practitioners office.

If your pipes break and you need a plumber ASAP--you can get one--probably at triple time and paying portal to portal. The local plumber's union doesn't have an "on call" list that obligates them to take their turn caring for your emergencies--regardless of your ability to pay. The local hospital will yank your priveleges if you don't oblige. So medicine is different from other forms of commerce, which is my point, exactly.

The problem with your argument is that yes, sometimes situations really are different. I am a physician (obviously) but in excess of 85% of what I do is routine/non emergent care. Most of the really acute stuff I deal with goes into the hospital through the ER, and the other few percent I just work in. So how does open access serve my patients or my practice?

It's funny that you say they aren't comparable, yet go on to make your hotel analogy as if they were.....

I'll agree that medicine is not like other commerce in many ways, neither is accountancy like construction, or auto mechanics like retailing, but there are things to be learned from the way other industry's treat their customers (patients). Medicine has a long history of firmly entrenching themselves is protocol and not changing no matter what the market demands, which in some cases is an abuse of power. Doctors don't have to change because they're doctors.

As to the specific case of scheduling, yes, certainly those routine or predicatable things should be scheduled, but the doctors need to do better at scheduling. I'm sick of going to a scheduled appointment and being seen an hour or more later. I hear the excuse that emergencies come up..Well, if you're a surgeon, or an obstetrician, you know emergencies are going to come up so your schedule needs to be less appointment intensive to accomodate. Instead the patient suffers so that the financials work for the practice.

How does open access serve your patients? You partially answered your own question. You work in your sicker patients.

The problem is the patients who must go to an emergency room for care of a problem better treated at their family practitioner. If my back hurts so badly that I cannot work then I cannot wait 2 weeks to be scheduled between other peoples routine check ups.

Is it possible that we have a lot of doctors who would like to spend their careers doing routine check ups on healthy people at 150 dollars per 10 minute visit?